Caracterización clínica e identificación de factores asociados a crisis hipertensivas en el servicio de urgencias

Abstract

Introduction: Arterial hypertension (AHT) can debut with a hypertensive crisis (HC), whose prevalence is 1-2%. They are classified as: urgency (HU), emergency (HE) and pseudocrisis (HP). Objective: To determine the clinical characterization and identification of factors associated with HC in the emergency service. Materials and method: Analytical cross-sectional study based on records of patients ≥18 years who attended the emergency room between 2020 and 2021 with blood pressure (BP) ≥180/120 mmHg and a confirmed diagnosis of HC. Prevalences were estimated, odds ratio and logistic regression models were calculated, with confidence levels of 95%. Results: The prevalence of HC was 1.7%. 59.4% were women, aged 66.34 ± 13.8 years, 88.7% had a history of hypertension. The most frequent chronic treatment was angiotensin II receptor blockers (ARB) (52.9%). The most common HC was HE (54.6%). BP levels were higher in the HE group (p < 0.001). Headache was the most frequent symptom (30.0%). Chronic use of angiotesin-converting enzyme (ACE) inhibitors was associated with a lower probability of presenting with HE (68%). Chronic kidney disease was associated with an increased probability of HU (OR = 2.77; CI 95% = 1.31-5.87), coronary heart disease and cerebrovascular disease with an increased probability of HE (OR = 3.11; CI 95% = 1.31-5.87). CI 95 = 1.15-8.45 and OR = 4.4; CI 95% = 1.69-11.58). The most used therapy for HU and HP was losartan (47.56 and 43.14%), for HE labetalol (48.75%). Conclusions: Knowing the frequency and association of HC allows to improve the medical assessment, the use of tests, their treatment and prognosis.